| Doctor Name: | DR. MYRNA JACOBSON |
| NPI Number: | 1295774230 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PSYCHOLOGIST |
| License Number: | 2616 |
| Business Practice Address: | 123 Weeminuche Ignacio, CO - 81137 |
| Business Phone Number: | 9705634581 |
| Business Fax Number: | 9705630206 |
| Mailing Address: | 1147 East Pioneer Drive, DURANGO |
| State: | CO |
| Postal Code: | 813019235 |
| Phone Number: | 9702592723 |
| Fax Number: | |
| NPI Enumeration Date: | 06/05/2006 |
| NPI Last Update Date: | 07/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 2616 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CO |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |